General Information

UCP Seguin of Greater Chicago is committed to do all it can to protect the vulnerable adults and children it serves from all forms of abuse, neglect, & exploitative victimization. To that end, this section includes person background information necessary to ensure we exercise due diligence in screening any person before s/he is authorized for regular access to the UCP Seguin workplacem its program sites and for ongoing contact with its participants and staff.

We recognize that many people have made mistakes in the past. A conviction record will not necessarily be a bar to volunteering. Factors such as age & time of the offense, seriousness, rehabilitation and nature of the offense will be taken into account.

We need you to answer all questions truthfully so that we can discuss any problems you may have had in advance of the selection process. Please be advised that we must conduct a background check, including but not limited to criminal convictions, driving record, etc. to ensure our participants safety. Therefore, any false or omitted answers to application questions will result in your application being rejected.

PURSUANT TO CRIMINAL IDENTIFICATION ACT 20 ILCS 2630/5: APPLICANTS ARE NOT REQUIRED TO DISCLOSE SEALED OR EXPUNGED RECORDS OF CONVICTION OR ARREST.

Volunteer Information

Please list your most recent volunteer experience.

If you have no previous volunteer experience, please enter N/A in the boxes below.

Employment Information

Please list your most recent work experience.

If you have no previous work experience, please enter N/A in the boxes below.

Educational Information

Please provide your educational history.

BUSINESS/PROFESSIONAL REFERENCES

Note at least one person who had opportunity to observe and assess your work skills, abilities and qualifications (i.e. professional associate, previous coworker, manager, teacher, customer etc.).  Please notify the person(s) you list that UCP Seguin may be contacting them to give a reference for you.

Personal References

PERSONAL REFERENCES

Note at least one person who know you well enough to respond to questions about your character, integrity or other related qualifications whom you have known for more than one year and with whom you have maintained contact within the last year.  Please notofy the person(s) you list that UCP Seguin may be contacting them to give a reference for you.

Volunteer Hours

Volunteer Locations

Volunteer Interests

Notification and Agreement

I certify that all answers given by me are true, accurate and complete.  I understand that the falsification, misrepresentation or omission of fact on this application (or any other accompanying or required documents) will be cause for denial of approval to access UCP Seguin premises and program sites or immediate termination of such approval, regardless of when or how discovered.

I authorize the investigation of all statements and information contained in this application.  I release from all liability anyone supplying such information and I also release the employer from all liability that might result from making an investigation.

If approved, I agree to abide by all of the Agency rules and regulations including those pertinent to the rights of UCP Seguin participants and staff, who I may encounter while on UCP Seguin premises and understand that, is approved to access UCP Seguin premises, such approval may be revoked with or without cause, and with or without notice, at any time, at the option of either the Agency or me, I further understand I acknowledge that I have read and understand the above statements and hereby grant permission to confirm the information supplied on this application by me.